This window allows you to change some of the information you entered when you registered. In addition, you can indicate here whether your status with the business has changed.
Warning: For provider, payor and payee businesses, changes made on this page will not be forwarded to HFS's mainframe systems. To make changes to information carried on the Department's files, you must contact HFS's Provider Participation Unit (PPU).
If you are an active administrator for a Medicaid provider, payor or payee, you can also contact HFS's Provider Participation Unit by e-mail from this page by clicking on the PPU link.
To change registration information, your relationship with the business must be in an active or pending status.
Your registration and authorization information is used by applications available through the MEDI System. The following rules apply to any changes to this information:
HFS ID Number. This number is assigned by HFS and cannot be changed.
Tax ID Number. You will need to re-register under the new tax ID number if your tax ID number changes.
If you are an employee, you are only allowed to change your personal phone, extension and e-mail address.
Status. You are allowed to terminate your relationship with a business. Review the Terminate Your Business Relationship topic for more information on how to change your status.
Applications. This option is dependent on your registrations and authorizations, and cannot be changed on this page.
Relationship. After you have registered, you can change your relationship with a business in the MEDI System from employee to Administrator and visa versa, as long as certain conditions are met. Review the Change Your Business Relationship topic for more information on how to change your relationship.
Field Name |
Definition |
Validation Rules |
Field Type |
|
HFS ID Number |
the business' identification number with HFS |
N/A |
Display Only |
|
Tax ID Number |
the business' tax identification number |
N/A |
Display Only |
|
Business Name |
the business' name |
Available to the Administrator only. Required. Must be at least 2 characters in length. Certain special characters are not allowed. |
Text Box |
|
Status |
the status of your registration with the business |
N/A |
Display Only |
|
Application |
the applications you are authorized to access for this business |
N/A |
Display Only |
|
Relationship |
your relationship with the business |
N/A |
Display Only |
|
Business Address |
the business' street address |
Available to the Administrator only. Required. Address must be at least 3-characters in length. Certain special characters are not allowed. |
Text Box
|
|
Employee Registration Key |
the key which associates employees registering for a business with the correct business record |
N/A |
Display Only |
|
Business Second Address Line |
additional address information for the business |
Not required. If entered, address must be at least 3-characters in length. Certain special characters are not allowed. |
Text Box |
|
Click Here if you no longer work for this business |
a checkbox for terminating your relationship with the business; if you check this box and click the Submit button, your status with the business will be changed to inactive |
Not required. |
|
|
City |
the business' city |
Available to the Administrator only. Required. City must be at least 2 characters in length. Certain special characters are not allowed. |
Text Box |
|
State |
the business' state |
Available to the Administrator only. Required. Must be a valid state abbreviation. |
Dropdown Box |
|
ZIP Code |
the business' 5- or 9-digit ZIP code |
Available to the Administrator only. Required. Formats |
Text Box |
|
Business Phone Number |
the business' main phone number |
Available to the Administrator only. Required. Formats |
Text Box |
|
Business Fax Number |
the business' fax number |
Available to the Administrator only. Not Required. Formats |
Text Box |
|
Your Work Number |
your phone number at work; if you do not have a direct line, enter a phone number where you can be reached at work |
Required. Formats |
Text Box |
|
Your Work Ext |
your phone extension number at work, if you have one |
Not Required. If entered, must be numeric. |
Text Box |
|
Your Work E-Mail Address |
your work e-mail address, if you have one; if not, enter your personal e-mail address if it is accessible to you while at work |
Required. Must be a valid e-mail format. |
Text Box |